110 The Journal of Cosmetic Dentistry Fall 2005 Volume 21 Number 3

O
ne of the hottest topics in the dental industry is the debate about which
is better for indirect veneer restorations: pressable ceramics or multi-
layered powder-liquid feldspathic porcelain. Both of these techniques have
advantages and disadvantages.
In most esthetic-conscious dental laboratories, the decision about which
modality will be used to restore a case is made after a conversation between
the doctor and technician. This step is critical to the success of the case and
assurance of patient satisfaction. But what happens when this decision is left
entirely up to the laboratory technician? What would you, the laboratory
technician, recommend to the restoring dentist? Would you choose the sys-
tem with which you are the most comfortable and have the most experience?
Of course you would. But what if you have a high level of experience with
both systems?
The success of any case, regardless of the system used, is based on proper
preoperative communication between the dentist and the technician.
GUIDELINES
The following guidelines are suggestions based on what has worked well
for me. They are subjectivethere is no right or wrong answer.
I would choose pressed ceramics when
increasing incisal length more than 23 mm
closing diastemas greater than 23 mm
restoring severe wear cases or full-mouth reconstruction cases, due to
the fact that pressed ceramics are inherently stronger and more durable
1
combining veneers with full coverage restorations.
Pressed Ceramics Versus Layered
Feldspathic Veneers:
A Rationale for Modality Selection
CLINICAL SCIENCE HAUPT
John Haupt is the founder and president
of Haupt Dental Lab, Inc. in Hunting-
ton Beach, CA. He lectures both na-
tionally and internationally on bioes-
thetic and cosmetic dental laboratory
procedures. Mr. Haupt received his Ac-
creditation status with the AACD in
1992 and in 1996 obtained his Fellow-
ship. He has served as a chairman of
the Academys Lab Accreditation Com-
mittee, as well as a member of the Board
of Directors. Mr. Haupt has served as a
visiting professor at the Esthetic Den-
tistry Continuum at the University of
California, Los Angeles; and is currently
a faculty member of Orognathic Bioes-
thetics International in Salem, Oregon,
where he teaches the concepts of the bio-
logic model.
by
John Haupt, M.D.T.

Volume 21 Number 3 Fall 2005 The Journal of Cosmetic Dentistry 111
I would choose layered feldspath-
ic veneers when
restoring tetracycline-banded
discolored preparations, be-
cause layered porcelain powders
provide more exibility with
respect to choice of opacity and
translucent areas
2
doing conservative cases (e.g.,
younger people with large
pulps), because less tooth struc-
ture needs to be removed.
These guidelines may be oversim-
plied. Again, they are subjective
and should be considered second-
ary to the most important quality,
experience. The success of any case,
regardless of the system used, is
based on proper preoperative com-
munication between the dentist and
the technician.
There are essentially two differ-
ent methods available when fabri-
cating multi-layered powder-liquid
feldspathic all-porcelain restora-
tions: the old dog platinum foiled
system and the more contemporary
refractory die system. I favor the foil
technique due to many years of fa-
vorable results.
CASE STUDY
The following describes a case
utilizing multi-layered powder-liq-
uid build-ups on platinum foil ma-
trices.
The patient was a 26-year-old
dental student at New York Univer-
sity, who felt that the accelerated
wear on her four anterior incisors
needed to be addressed (Fig 1).
After initial discussion with the re-
storing dentist, we received study
models and pictures prior to any
preparations or nal diagnosis. The
immediate question was, What has
caused the accelerated wear on this
young woman? The answer: occlu-
sal interferences.
3
The case was diagnosed with an
open bite tray registration technique
and mounted on a semi-adjustable
articulator (Panadent Corp.; Grand
Terrace, CA) on the hinge axis, which
detected a centric relation/centric
occlusion (CR/CO) discrepancy
(Fig 2). An occlusal appliance known
as a maxillary anterior guided or-
thotic (MAGO) was constructed.
4

The patient was compliant and wore
the MAGO long enough to facilitate
an occlusal coronaplasty (equilibra-
tion) of her interferences, which
turned out to originate from the
posterior region of her mouth.
We received new models after
equilibration and again diagnosed
using instrumentation to ensure
that CR = CO (Fig 3). Using smile
guides to demonstrate different inci-
sal characteristics, the patients pref-
erences were documented and trans-
ferred to the mounted study models
in wax.
After verifying that the wax-up
provided the desired anterior guid-
ance, the wax-up was duplicated in
stone to facilitate fabrication of a
custom provisional matrix (Fig 4).
Traditional vacuum-formed stents
are subject to the following prob-
lems: the relatively thin 0.3.5-mm
stent material works well to capture
intimate detail, but fails to provide
proper intraoral orientation (Fig 5).
As a result, the provisionals are al-
most always distorted. The thicker,
CLINICAL SCIENCE HAUPT
Figure 2: Preoperative model showing wear.
Figure 1: Patient, before.

112 The Journal of Cosmetic Dentistry Fall 2005 Volume 21 Number 3
CLINICAL SCIENCE HAUPT
Figure 3: CR=CO adjusted models with
anterior wax-up.
Figure 4: Duplicated models of wax-up.
Figure 5: Double-laminated stent formed
over wax-up model.
Figure 6: An accurate 0.3-mm stent on left and a
rigid 1.5-mm stent on the right.
Figure 7: Minimal reduction preparation for layered
feldspathic veneers.
Figure 8: Stent placed in mouth ready for
provisionalization.

Volume 21 Number 3 Fall 2005 The Journal of Cosmetic Dentistry 113
more robust 11.5-mm material
provides a more stable intraoral ori-
entation, but unlike the thinner
material, does not capture intimate
detail. As a result, the accuracy of the
provisionals is less than desired.
In this case, the solution to the
problem was to create a combina-
tion of both materials (Fig 6). How-
ever, this technique proved to be
inefcient with traditional vacuum-
forming machines. What is needed
to fabricate this type of stent is posi-
tive pressure and properly heated
materials. The unit we found to be
successful was the Biostar (Great
Lakes Orthodontics; Tonawanda,
NY) pressure molding machine.
The Biostar temporary stent serves
many different functions:
The dentist can use it to make
provisionals that represent the
wax-up. The material is durable
enough for multiple applica-
tions if needed.
The stent can be used as an in-
traoral reduction guide because
it is transparent.
The dentist can ll it with
composite to generate intraoral
mock-ups that allow the patient
to see what he or she will look
like with increased incisal
length and facial contour if
desired.
It can be used as a preliminary
bleaching tray.
The importance of careful seating
and contouring of the provisionals
according to the patients
expectations cannot be emphasized
enough.
The patients dentist and I dis-
cussed the possibility of using
minimally invasive multi-layered
powder-liquid feldspathic porce-
lain veneers. The decision was based
on the fulllment of the previously
mentioned criteria: lengthening of
no more than 2 mm, no noticeable
discoloration of preparations, and a
young patient (Fig 7).
After preparation of the six maxil-
lary anterior teeth, we used the Bio-
star stent to make the provisionals.
At this time it is possible to add or
subtract to the temporaries accord-
ing to patient preferences (Fig 8). I
believe that this is by far the most
critical step in the success of the nal
product; this is the patients chance
to express personal wishes with re-
spect to shape and arrangement of
the nal restorations.
The importance of careful seat-
ing and contouring of the provi-
sionals according to the patients
expectations cannot be emphasized
enough. If the patient is not happy
with the form of the provisionals it
will be very hard for the technician
to guess the desired shape and
contour that will please the patient
(Fig 9).
Once the patient has accepted
the shape and contour of the provi-
sionals, an impression is taken and
poured in stone. This study model
of the provisionals can now be
mounted against the opposing teeth
and a silicone putty index can be
formed to the incisal edges as well
as the labial contours. This index
aids the technician in the planning
and build-up of the nal porcelain
restorations (Fig 10).
The models were pinned and
mounted on a semi-adjustable ar-
ticulator and the individual dies
CLINICAL SCIENCE HAUPT
Figure 9: Provisionals made from the stent. Figure 10: Silicone index made from a model of the
accepted provisionals.

114 The Journal of Cosmetic Dentistry Fall 2005 Volume 21 Number 3
CLINICAL SCIENCE HAUPT
Figure 11: Incisal imprint of study model provides
guide for the ceramist.
Figure 12: Platinum foil adapted to the dies ready for
porcelain layering.
Figure 13: Translucent gingival porcelain as rst
layer.
Figure 14: A diluted dentin powder was used for body
porcelain.
Figure 15: The second layer produced a light
translucent body.
Figure 16: Multiple enamel overlays of translucents.

Volume 21 Number 3 Fall 2005 The Journal of Cosmetic Dentistry 115
were foiled with .001-in. (.025-mm)
platinum foil (Williams, Ivoclar
Vivadent; Amherst, NY) (Fig 11).
An old-fashioned swager ensured
an intimate t to the stone dies. The
proximal excess foil was trimmed to
make sure the dies would t into the
base of the model (Fig 12).
We decided to utilize the contact
lens effect at the gingival to cre-
ate an illusion of a disappearing
margin (Fig 13). A half-and-half
combination of A1 dentin pow-
der and clear incisal porcelain was
mixed and layered at the gingival.
The interproximal was cut using a
thin blade and the porcelain was
red. This layer of gingival porcelain
acts as a stable matrix for the future
layers.
The second layer needed a lighter
shade than A1, but I have found that
the so-called bleached shades are too
opacious and blotchy when used in
thin areas (Fig 14). A half-and-half
mixture of A1 and enamel white was
used to create the desired effect on
the body of the restorations. Undi-
luted A1 was used for the canines.
The second layer produced a light
translucent matrix for the enamels
and internal coloring (Fig 15). A1
opacious dentin was used for the
dentinal lobes. The length and an-
gulations were assessed at this time
and corrections done accordingly.
Enamel and translucent overlays
are the keys to beautiful and natural
restorations (Fig 16). The balance
between too much and not enough
is a ne line. There is no specic
formula for the amount of enamel
overlay, but it is up to the technician
to study the pictures provided by the
dentist or, if possible, the patient in
person. This patients natural enam-
el had numerous colors and many
levels of translucency. As a rule of
thumb when studying enamels, I
always say the more the merrier. I
typically use a combination of blue,
yellow, white, opal, clear, and super-
clear.
One of the many advantages of
the all-ceramic restorations is that
multiple rings will not gray out
the porcelain (Fig 17). With all-ce-
ramic restorations there is no gray
oxide migration from the metal; it
is possible to add multiple layers
of translucent and opalescent un-
til the desired form and color have
been obtained. The silicone index
made from the study model of the
accepted provisionals is invaluable
at this time to ensure proper incisal
edge contour.
The foil technique can provide
a very good t if proper care in
adapting the foil and removing it
is exercised. As with any sensitive
techniques, there is a learning curve
involved (Fig 18).
One of the most important steps
in ensuring the t of porcelain ve-
neers (or any restoration made in
the dental laboratory) is to carefully
seat every unit on a solid model that
has been trimmed around the mar-
gins (Fig 19).
Seating porcelain veneers with a
translucent medium allows the nat-
ural tooth color to blend naturally
with the color of the thin porcelain
(Fig 20). This concept is similar to
the way Mother Nature uses enamel
as the prism to display the colors of
the dentin. The thinness of the ve-
neers permits the dentist to use a
CLINICAL SCIENCE HAUPT
Figure 17: Final enamel ring. Figure 18: The foil technique can provide excellent t.

116 The Journal of Cosmetic Dentistry Fall 2005 Volume 21 Number 3
light-cure as well as a dual-cure resin
to bond the restorations (Fig 21).
SUMMARY
The many all-ceramic systems
available to dentists and dental
technicians today offer choices
like never before. The conservative
multi-layered powder-liquid feld-
spathic porcelain on platinum foil
technique is not for every case, but
it certainly should be considered in
cases similar to the one described
here (Fig 22).
References
1. Magne P, Kwon KR, Belzer UC, et al. Crack
propensity of porcelain laminate veneers:
A simulated operatory evaluation. J Pros-
thet Dent 81:327-334, 1999.
2. Bassett J, Patrick B. Restoring tetracycline-
stained teeth with a conservative prepa-
ration for porcelain veneers. Pract Proced
Aesthet Dent 16(7):481-486, 2004.
3. Hunt K, Haupt J. Bioesthetics: An interdis-
ciplinary approach to improve function
and appearance. AACD Journal 14(1):36-
44, 1998.
4. Dyer E. The importance of stable max-
illo-mandibular relation. J Prosthet Dent
30(3):241-245, 1973.
______________________

CLINICAL SCIENCE HAUPT

Figure 19: Final veneers tted to solid model. Figure 20: Seated veneers showing high level of
translucency.
Figure 21: Close-up shows the blending contact lens
effect.
Figure 22: The smile says it all.